Combined ‘trache-stent’: a useful option in the treatment of a complex case of subglottic stenosis

Abstract

The authors describe the adaptation of a Montgomery T-tube laryngo-tracheal stent to incorporate an uncuffed fenestrated Shiley tracheostomy tube in the management of a complex case of subglottic stenosis. The combined 'trache-stent' provided a secure, unobstructed airway and optimal phonation. The presence of a removable inner tube facilitated cleaning and reduced patient anxiety regarding the perceived risks of stent obstruction with dried secretions. The combined 'trache-stent' was upsized at four weeks with minimal evidence of local granulation formation. The device was removed entirely six weeks later after direct laryngoscopy reconfirmed the above findings. Almost two years later the patient retains a good voice and airway using a simple fenestrated tracheostomy tube and speaking valve. The subglottic area is stable and the patient has returned to full-time employment.

Role of Montgomery T-tube in laryngotracheal stenosis

“…19,20 Stenting remains a relatively conservative treatment, is successful in a proportion of cases, and does not preclude the possibility of future reconstructive surgery if it fails. The tracheal T-stent initiates little or no tissue reaction unless it touches the under surface of the vocal cord.…”